Diagnosis

Axillary lymph nodes often feel like small, round "sponges" under the skin. Sometimes they are painful to the touch. A doctor will investigate if the cancer may have spread to the lymph nodes by doing a physical examination.

The doctor will feel around the collarbone and neck for signs of enlarged lymph nodes, as well as underneath the arm.

According to the Susan G. Komen Breast Cancer Foundation, one-third of women who do not have lymph nodes that can be felt in a physical exam are found to have cancerous lymph nodes after further testing. As a result, it is usually vital to conduct more testing after the initial physical exam.

A doctor has several different diagnostic methods to determine if the cancer has spread to the axillary lymph nodes. These include:

Sentinel node biopsy

A sentinel node biopsy involves injecting a radioactive substance or dye into the breast. A doctor will then use imaging to identify the lymph nodes the dye goes to first. These first lymph nodes are known as the sentinel lymph nodes.

A doctor will remove one and send it to a pathologist who specializes in identifying types of cancerous cells. This approach can save a person from the side effects of removing multiple axillary lymph nodes.

According to the Susan G. Komen Foundation, sentinel node biopsy correctly predicts the status of further lymph nodes in 96 percent of women with breast cancer.

Axillary dissection

Axillary dissection is a procedure that involves removing more lymph nodes under the armpit. This is done by removing an area of fat that contains many or all of the lymph nodes. A doctor will then test these for cancer to determine if it has spread beyond the sentinel lymph node and, if so, how far it has spread.

After surgery, sometimes the lymph nodes are radiated along with breast radiation to target any possible remaining cancer cells.

Staging

A doctor will check for signs of enlarged lymph nodes around the collarbone and neck.

The staging of a person's cancer is a part of the TNM system, which stands for Tumor, Nodes, and Metastasis.

Some doctors use the TNM system to help them provide a prognosis or an outlook for how likely they are to be able to treat a person's breast cancer successfully.

The N staging categories include:

NX: Axillary lymph nodes cannot be assessed, for example, if they were previously removed.

N0: Cancer has not spread to the lymph nodes. However, a doctor may choose to perform other types of tests to determine if microscopic amounts of cancer cells are present in the lymph nodes. These cells are known as micrometastases.

N1: Micrometastases or cancerous cells are present in 1 to 3 axillary lymph nodes, or the internal mammary nodes have tiny amounts of cancerous cells.

N2: In this stage, 4 to 9 axillary lymph nodes have cancer present, or the internal mammary nodes have cancer

N3: This stage has a broad spectrum, as follows:

cancer has been found in 10 or more axillary lymph nodes

cancerous lymph nodes are found under the clavicle

internal mammary nodes have cancer plus one or more axillary lymph nodes are cancerous

four or more axillary lymph nodes are cancerous and internal mammary nodes have micrometastases

cancerous nodes are detected above the clavicle

The more nodes and types of nodes involved, the higher the staging category for axillary lymph node status.

Prognosis

The prognosis is poorer when a person's cancer has spread to their lymph nodes, especially when it has spread to more of these.

However, lymph node staging is only one piece of the puzzle for cancer prognosis.

A doctor will also consider the overall size of a person's tumor, the type of cells present, and if the cancer has spread to other organs.

These factors and other considerations, such as a person's overall health and medical history, can further affect the prognosis they will receive.

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Comments(2)

I believe staging is an out of date methodology that infers that there is a nice serial progression of cancer spread, But there is not. The more we learn about cancer, the more we realise that cancer can spread past the lymph nodes very early on. Having only one, or 2 lymph nodes involved is no indicator.

Doing radical lymph node removals "because" is going the way of radical mastectomies because surgeons and oncologists are realising that it can do more long term damage to the patient that good. Lymphodema is a chronic and sometimes crippling condition.

I listened very carefully to my surgeon, and was quite horrified at the thought of having a vital internal system cut out blindly (her words not mine) because that's the conventional wisdom. Fortunately she also listened to me, and we agreed on a smaller removal which revealed only a couple of nodes with cancer - but later tests showed metastases elsewhere - so dooming me to chronic lymphodema would have been an utter waste of time, and at this stage worse than the cancer which is giving me no trouble at all! Significantly reducing cancer patients quality of life, when they could otherwise be in 'good health' needs to be carefully considered by surgeons and oncologists - who must have full discussions with their patients. Removal is irreversible.

My personal opinion is also that needle biopsies need to be eliminated as a method of diagnosis!! When I went in for mine I thought it would be a simple needle in, draw plunger back with little disruption of the area. Instead these are horrific procedures (there was no pain, but the methodology is extremely injurious to the area) that I believe are surely a way to spread cancer cells far and wide. Given the timeline between diagnostic procedure and later surgery - do we have any good studies showing that these diagnostic procedures aren't causing metastases?

Vets rarely do needle biopsies on tumours these days - for exactly this reason. Get in, take out the tumour with good margins, remove suspicious lymph nodes with as little damage as possible and don't help the cells spread. Do the pathology on the removed materials AFTER.

Seems no research is being done to remove lymph other than massage therapy or wrapping it seems arcaic to depend on this method. I live in a state without certified Lymphadema trained therapist one I had from California moved to Florida.

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